Candidiasis (Thrush)

Candidiasis or Candidosis OR Thrush is a yeast infection caused by any Candida species. Candida albicans is the most common agent causing infections in humans. The infection is commonly called 'thrush' or 'moniliasis'.

Candida occurs freely everywhere and their infections can affect the body in many ways. From small localized areas of infection in some or fast-spreading multi-system infections in others, Candidal infections can be superficial or life-threatening.

Who gets Candidal infections?

Candida is normally present in most people. The organism is a commensal i.e. it naturally colonizes the human body without benefiting or damaging it.

A healthy immune system and the presence of other microorganisms, check its uncontrolled multiplication and thereby, infections.

It is an opportunistic organism causing an infection only when your immune defenses are lowered enough for it to multiply. Carriers generally don't develop any symptoms so long as they are healthy. Yet, the incidence of Candidiasis is common among

Infants

Elderly people

High sugar diets

Women on oral contraceptive pills or Hormone Replacement Therapy

Use of natural progesterone cream

Pregnancy

Dental mercury amalgam poisoning

Smoking

Other heavy metal poisonings e.g. lead, cadmium

Chemical poisoning from the home, garden, workplace etc.

Hormonal changes e.g. puberty, pregnancy, menopause

Most often these infections are localized. Many clinical/medical conditions also increase the risk of acquiring Candidiasis. In such cases where the immune system is lowered, the infection spreads through the blood stream and spreads to other organs as well.

A low immunity plus Candidiasis is possible in the following situations:

Diabetes mellitus. Recurring infections in spite of proper treatment is a feature of diabetes. High glucose levels in the blood allow rapid spread of the infection to other body parts by the bloodstream.

Use of broad-spectrum antibiotics. This usually kills the other organisms that compete with Candida for growth and allows the yeast to grow unchecked.

Obesity. The moisture within skin folds provides a suitable environment for yeast growth.

Intravenous drug abuse. Frequent, unhygienic insertion of drugs via the intravenous route, or long dwelling IV lines can introduce Candida into the bloodstream.

Reduced numbers of neutrophils (a component of the white blood cells which are the defense cells of our bodies).

Neonates. Infants less than 7 days old.

Prolonged steroid (corticosteroid) therapy.

AIDS. People suffering from AIDS are very susceptible to Candidiasis.

Stress and poor nutrition. These are known and proven immunosuppressant. It certainly lowers the body's immune status making it vulnerable to infections.

Symptoms

Candidal infections are extremely common. It occurs in otherwise healthy people mostly as a well-localized infection and responds favorably to treatment.

Affected locations show a lot of itching, burning, and soreness. Generally, symptoms depend upon the organ involved.

In the oral cavity, its presentation is called oral thrush. Most infections are seen in people having AIDS and in infants. Infants may suffer from

Pain

Poor feeding

Crankiness

Lethargy.

It presents as discrete lesions on the penis and foreskin. Often the soft tissue of the glans penis has red, inflamed, painful sores and rarely a white discharge from the penis. A condition called 'balanitis'.

In infants and older children using diapers, it presents within the folds of the skin as 'diaper (nappy) rash'.

Nipples and surrounding tissues, in breastfeeding women.

The ears. External ear often gets infected.

Endophthalmitis, a condition wherein the inner eyeball is inflamed is typical of Candidal infection. The most common symptoms are:

Pain

Blurred vision

Decreased vision

Redness, especially after eye surgery
Children with low birth weight or hospitalization for long periods are contributing factors.

Nails. It causes chronic paronychia which is painful inflammation of the tissues around the nail. It also causes onychomycosis where the nail grows very poorly and appears disfigured.

The skin surrounding the nose and margins of the nostrils can be affected.

In women, a fairly common site is the vulva or vagina. The condition is referred to as vaginal Candidiasis or vaginal thrush.

Intense itch and profuse creamy-white, curd-like or a whitish-yellow discharge from the vagina is the commonest symptom.

Soreness and burning.

Pain during sexual intercourse.
The third trimester of pregnancy, broad-spectrum antibiotics, sexual activity (anal sex followed by vaginal sex, without proper cleaning), use of oral contraceptives and HIV infection are some of the most common factors causing vulvovaginal thrush.

The skin folds are prone to a lot of moisture. Obesity, Diabetes, excessive sweating (hyperhidrosis) are common causes of Candidiasis in the skin folds.
Lesions show the following characteristics

Systemic symptoms

Candida spreads throughout the body and causes a multitude of symptoms. Extent of infection, severity, and their consequences largely depend upon the individual infected.

Candidiasis of the esophagus (food pipe) along with mouth infection is highest in people suffering from AIDS.

Respiratory system involvement is mostly seen in the form of a cough and fever.

Candidal infection can cause prolonged fevers (fevers of unknown origin) in absence of other specific symptoms.

Addison's disease, Underactive thyroid disorder, and Diabetes can promote the growth of Candida.

Diagnosis

Culture Studies

Materials used to obtain cultures are:

Skin scrapings

Urine samples

Bronchial washings.

Sputum cultures.

However, since Candida is a commensal, a positive culture test need not be diagnostic of widespread invasive infection. The key to a positive diagnosis lies in the identification of a Candidal skin lesion and its histopathological study revealing the presence of growing yeast cells.

Treatment options for Candidiasis

Conventional treatment:

When the symptoms are vague, physicians end-up treating Candidiasis with antibiotics. This further increases the severity of the infection as it eliminates the natural competitors of Candida helping it grow unchecked.

All conditions like diabetes, obesity, HIV-infection, neutropenia, steroid therapy, contraceptive pills & HRT, etc. that increase the vulnerability to the infection have to be separately reversed or controlled.

Prevention

Here are some tips to keep Candidiasis at bay!

Eat healthy

Many foods can make us vulnerable to Candidiasis. To thoroughly avoid them is easier said than done. If you already suffer from the infection, it is best to avoid them. If you are infection free but know you're prone to recurrent Candidiasis, then you need to maintain a healthy balance and have these foods with care and moderation. The 'Candida Diet' is known to help contain the infection to a large extent.

Some foods to have with caution are:

Foods high in sugars - cakes, pastries, jams, syrups, canned syrups, chocolate, honey, molasses, biscuits, puddings, marzipan, ice-creams, soft-drinks etc. Many food packages even disguise the presence of sugars by using terms like sucrose, dextrose, fructose, lactose etc. In short, sugar in any form is best avoided! Even artificial sweeteners are equally harmful.

Fermented foods like beer, cider, wine, pickles, etc. Alcohols eventually get converted into sugar thus in increasing the sugar content in the bloodstream allowing Candida to grow.

Nuts. Most nuts are very moldy. Hence, if you have Candidiasis, avoid nuts.

Tea, coffee, hot chocolates or any malted drinks (e.g. Horlicks).

Try having more of

Whole wheat, whole bread products. Drink milk and have more of yogurts rich in lactobacilli, a normally occurring gut bacterium which keeps a check on Candida growth. Garlic is known to have natural anti-fungal properties.

Exercise

A sedentary lifestyle contributes to the development of Candidiasis, particularly in women and in people chronically bed-ridden.

Sanitation

The importance of maintaining a high standard of personal hygiene cannot be disregarded.

Wear loose clothes and undergarments must have a cotton crotch.

After toilet, wipe from front to back only. This prevents contamination of the vagina with anal microorganisms.

Keep the vaginal area always dry. Especially after a bath or shower. Be sure to wash the area thoroughly when in a bath or shower. Avoid very strong soaps.

If you exercise or swim, change out of the clothes immediately after the workout.

Douching should be avoided.

Avoid using highly perfumed scents or soaps.

Undergarments must be washed in warm water and softeners should be used sparingly.

Scented sanitary pads or tampons are best avoided. Change the pads frequently, keeping the area dry.

Avoid sharing towels, razors and other toiletries.

Practice safe sex

Genital Candidiasis often spreads through infected sexual partners. Often both partners need to undergo treatment.

Both partners should clean themselves before and after having sex.

Use a condom if either partner is infected or undergoing treatment.

Avoid vaginal sex immediately after anal sex and never without washing.

Use lubricants when the natural secretions are insufficient.

Always use water-based lubricants only.

Ease up on your medications

Indiscriminate use of antibiotics can gradually make the bacteria resistant to them. Thus, very often you end up using more and more potent antibiotics. You really do not need an antibiotic for that cold or tummy ache. Frequent antibiotic usage kills other organisms that compete with Candida and help its growth. Besides, all antibiotics come with their own share of side-effects. So, stop popping pills at the drop of a hat!

Women suffering from Candidiasis must find alternatives for their contraception. Check with your doctor before having pills to avoid pregnancy.